Persistent Septal Deviation After Septoplasty: Causes and Surgical Management

Abstract Purpose: Septoplasty is one of the most common surgical procedures performed by otolaryngologist. There are various causes of persistent septal deviation after primary septoplasty. The purpose of this study was to identify the associated factors affecting the failure of the primary septoplasty, and to investigate operative techniques for correcting residual septal deviation, as well as surgical outcomes. Methods: Seventy-four adult patients underwent revision septoplasty for persistent septal deviation was included. The level of hospital where primary septoplasty was performed, type of septal deviation, persistent deviated septal portion, and techniques used to correct the residual deviation were evaluated. Subjective outcomes using visual analog scale (VAS) and acoustic rhinometry data were assessed. Results: The first septoplasty was performed mainly in primary and secondary hospital. C-shape was more common than S-shape deviation in the anteroposterior and cephalocaudal dimensions. The most common areas of persistent septal deviation were caudal septum (44.6%) followed by multiple sites (20.3%). Correcting techniques included excision of remnant deviated portion (70.3%), septal cartilage traction suture (27.0%), spreader graft (13.5%), and crossing suture (6.8%). There was significant symptomatic improvement in the VAS at 6 months postsurgery. The minimal cross-sectional area and nasal cavity volume of the convex side were significantly increased after revision septoplasty. Conclusion: The patients underwent septoplasty in primary and secondary hospital were more likely to undergo revision septoplasty. Caudal septum was the most common sites of persistent septal deviation. Preoperative careful evaluation for caudal septal deviation characteristics and selection of the appropriate surgical techniques may lead to reduction of the need for revision septoplasty.